Stomach

Question 1

What conditions predispose to PICA?

Answer 1

• pancreatic exocrine insufficiency
• hepatic encephalopathy
• iron deficiency

Question 2

What are the common clinical signs associated with a gastric foreign body?

Answer 2

• vomiting most common

- dehydration and lethargy

Question 3

What is found on physical exam of a dog with a gastric FB?

Answer 3

• distended abdomen
• hematemesis
• melena

Question 4

What laboratory findings can be present in a dog with a gastric FB?

Answer 4

• hemoconcentration or anemia
• azotemia
• alkalosis or acidosis
• hypokalemia
• hypochloremia

Question 5

How can is a gastric FB diagnosed?

Answer 5

• radiographs
• ultrasound
• endoscopy

Question 6

What is the treatment/therapy for a gastric FB?

Answer 6

• stabilize patient: fluids, gastroprotectants, analgesics
• lead (chelation), zinc (tranfusion)
• endoscopy or gastrotomy

Question 7

Describe the gastrotomy procedure for removal of a FB

Answer 7

• ventral midline incision from xyphoid to pubis
• stab incision in center of vessels, then extend
• remove FB
• explore and lavage entire abdomen
• closure

Question 8

Which is the layer of strength in the stomach?

Answer 8

submucosa

Question 9

When is a single layer closure of a gastrotomy indicated?

Answer 9

• pyloric outflow tract
• reduced gastric volume
• thickened gastric wall

Question 10

Which animals are predisposed to congenital pyloric stenosis?

Answer 10

• brachycephalic breeds

- siamese cats

Question 11

What is congenital pyloric stenosis?

Answer 11

• gastric outflow obstruction

- hypertrophy of circular muscles

Question 12

What are the clinical signs associated with congenital pyloric stenosis?

Answer 12

• intermittent vomiting
• abdominal distension without pain
• normal to decreased body condition

Question 13

How is congenital pyloric stenosis diagnosed?

Answer 13

• radiographs
• ultrasound
• endoscopy

Question 14

What is seen on radiograph of a congenital pyloric stenosis?

Answer 14

• gastric distension
• delayed gastric emptying
• apple core sign with contrast

Question 15

How is congenital pyloric stenosis treated?

Answer 15

• Fredet-Ramstedt Pyloromyotomy

- Heinke-Mikulicz Pyloroplasty

Question 16

Describe Fredet-Ramstedt Pyloromyotomy

Answer 16

• no lumen exposure
• isolate pylorus and make surgical incision through serosa and muscular layer
• creates bulge which opens pylorus
• leave to heal on its own

Question 17

Describe Heinke-Mikulicz Pyloroplasty

Answer 17

• enters lumen of pylorus
• full thickness incision
• close in transverse orientation to help widen pyloric area

Question 18

Which animals are predisposed to acquired pyloric stenosis?

Answer 18

small breeds

middle-aged males

Question 19

What are the pathological classifications of acquired pyloric stenosis?

Answer 19

Grade 1 - muscular hypertrophy
Grade 2 - muscular and mucosal hypertrophy
Grade 3 - mucosal hyperplasia with muscular and submucosal inflammation

Question 20

What are the treatment options for acquired pyloric stenosis?

Answer 20

• transverse pyloroplasty
• Y-U pyloroplasty
• Billroth 1: pylorectomy with gastroduodenostomy

Question 21

Describe Y-U Pyloroplasty

Answer 21

• Y-shaped incision over pyloric antrum
• create full thickness antral flap
• pull flap down to base of the Y and suture it

Question 22

Describe pylorectomy with gastroduodenostomy

Answer 22

resecting entire affected pylorus and attaching proximal duodenum to stomach

Question 23

What are the clinical signs associate with gastric neoplasia?

Answer 23

• vomiting
• anorexia
• regurgitation
• melena
• hematemesis
• pain
• weight loss
• abdominal distension

Question 24

What are the lab findings associated with gastric neoplasia?

Answer 24

• anemia
• acidosis
• hypochloremia
• hypokalemia

Question 25

What is the most common gastric neoplasia in dogs?

Answer 25

gastric adenocarinoma

Question 26

What are the treatment options for gastric neoplasia?

Answer 26

- gastrectomy - Billroth 1 or 2 - chemotherapy

Question 27

What are the indications for a gastrectomy?

Answer 27

- neoplasia - ischemic injury - ulcer - trauma

Question 28

Describe the Billroth 2 procedure

Answer 28

- removal of entire pyloric antral area, significant portion of stomach, and part or proximal duodenum - side-to-side anastomosis of jejunum to stomach

Question 29

What are the complications of Billroth 2?

Answer 29

- alkaline gastritis (secretions in blind sac mix with gastric secretions) - blind loop syndrome (food enters blind sac) - marginal ulceration (jejunum receiving pyloric secretions)

Question 30

Describe the Roux-en-Y Anastomosis procedure

Answer 30

- resect significant portion of stomach up to proximal duodenum - resect duodenum by pancreatic ducts and anastomose on jejunum - stomach empties directly into duodenum

Question 31

Describe the features of a gastric leiomyosarcoma

Answer 31

- smooth muscle origin - affinity for cardia - causes gastric uleration

Question 32

Describe the features of a gastric leiomyoma

Answer 32

- benign, slow growing - no metastasis - may cause gastric outflow signs

Question 33

What is Pythiosis?

Answer 33

fungal disease that mimics gastric adenocarcinoma | - rapid growth rate an extensive

Question 34

How is pythiosis diagnosed?

Answer 34

- endoscopy - ELISA/SNAP - histopathology

Question 35

What is seen on histopathology of pythiosis?

Answer 35

eosinophilic pyogranulomatous inflammation

Question 36

How is pythiosis treated?

Answer 36

- resect as much tissue as possible - anti-fungals - immunotherapy

Question 37

What is the prognosis for pythiosis?

Answer 37

guarded to poor

Question 38

In which dogs do we more commonly see Pythiosis?

Answer 38

working/hunting dogs